March 24, 2016

WHAT’S UP, DOC? | The Price of Success

ByJack Stupinski | March 24, 2016

If you’ve ever taken a psych class, odds are you’ve heard of the Stanford marshmallow experiment. Children were told that they could either eat a marshmallow immediately or wait 15 minutes and have two marshmallows. Some of the kids gobbled up the marshmallow right away while others were able to hold out for the big payoff at the end of the test. The study was a landmark look at delayed gratification, and later studies showed that the kids who could hold out for that second marshmallow went on to greater academic and professional success than the kids who couldn’t. Delayed gratification equals success. Simple, right?

But, how does one measure success? If you’re an academic achiever (a safe assumption if you’re reading this column), you’ve probably delayed gratification most of your life to give yourself a shot at “success” after you graduate from school and/or training. In grade school, you work hard to get into a good high school, where you then work hard to get into a good college, where you subsequently work harder to get into a good company or graduate program and so on ad infinitum, so that you can ultimately be a “successful” person. In the medical field, with its extensive hierarchy — from medical student to resident to fellow to attending — this is especially true. But if you’re always working towards the next best opportunity, when do you actually reap the benefits of your hard work? When does the delaying stop and the gratification begin? And, how are we supposed to know what successes will make us happy when our education so strongly emphasizes those in the professional and academic arena? Is success really just hard-won achievement from sacrifice or is there something more?

I’ve been asking myself this question a lot lately as a third year medical student. Third year of medical school is made up of clerkships, large blocks of time where you join a medical team and learn how to manage the medical conditions within a given field, whether it be pediatrics, surgery or gynecology, to name a few. Third year is an exciting time when you actually see patients and apply what you learned in class, and it also serves as a critical chance to “try on” different fields for size and choose what kind of residency you want to apply to and therefore, what kind of doctor you want to be.

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Unsurprisingly, medical residencies and the fields they feed into vary widely in length, rigor, compensation and work-life balance. Choosing a residency is akin to choosing the trajectory for the rest of your career, along with your salary, hours and the demand on your personal life. Many students have to weigh factors such as when they want to start a family, how much compensation they hope to attain, how much time for their personal life they need and even whether the time and energy that goes into a residency and possibly even a fellowship is worth the payoff at the end, whatever that may be. Do I want to train in a large, prestigious academic program where more will be expected of me but I’ll have a stronger pedigree and stand on the cutting edge of medicine? What about a smaller community program that won’t turn as many heads on my resume but also won’t try to make me fight to become a leader in the field even if I just want a small private practice and a thriving family life? Do I want to reach further for the shinier brass ring or should I live a little and settle for one more within reach?

Ben Franklin often told a relevant parable based on his experience purchasing a whistle during his boyhood. Creatively titled, “The Whistle,” the parable details how young Benjamin, en route to a toy shop, instead purchased a whistle from a boy he met along the way with all of the money he had intended to spend at the store. Overjoyed with his purchase, he returned home with his prize. However, his enjoyment was cut short when his siblings pointed out how much he had overpaid for his new toy, and how much more fun he could have squeezed out of those extra coppers he overpaid with. The whistle then only served to remind him of his folly and he no longer derived any joy from playing with it. He had paid too much for his whistle.

Franklin tells this story to caution his readers against paying too much for the things we think we desire, lest the joy we take is overshadowed by the bitterness of the cost we pay. While he probably was talking about throwing your life away in fruitless pursuits, this risk is also ever-present when you’re a delayed gratifier. After years of climbing the academic ladder rung by rung, many of us reflexively reach for the biggest brass ring we can see, even if the cost means we are filled with bitter regrets when we look back on our lives filled with tangible achievements. Thoughts like “I wish I had spent more time with my kids when it mattered,” “work leaves me no time to enjoy my hobbies on weekends” or “I wish I had traveled more before I had all of these responsibilities,” are all too common when you get caught up in becoming the greatest achiever you can. Of course, plenty of people obtain real fulfillment from committing themselves completely to their work, and there is no one-size-fits-all for how to attain meaningful balance.However, everyone eventually reaches a limit on how long they can give 110% before drawing a line in the sand in order to give themselves a chance to live a little.

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So how are we to know when enough is enough?

Jack Stupinski is a third-year M.D. candidate at Weill Cornell Medical College in New York City. He may be reached at jas2069@med.cornell.edu What’s Up Doc? appears alternate Fridays this semester.